How much weight will I lose?
Our aim is to help patients lose between 60% and 100% of their excess weight (that is, the number of extra kilograms you are carrying over a BMI of 25). The final goal weight you reach depends on several factors including your build, body composition, sex and age. It also depends on how successful you have been in changing your dietary behaviours, lifestyle, and physical activity levels after surgery. The reason why we set a minimum goal of achieving 60% excess weight loss is because this level of weightloss will lead to maximal improvement in any weight-related co-morbidities. In general, most patients having the sleeve gastrectomy will reach their goal weight by 12 months, whilst most patients will get there by 18 months with the gastric band. This roughly equates to losing between 0.5kg-1kg per week, depending on your starting weight.
QUESTIONS ABOUT THE GASTRIC BAND
Will I feel hungry or deprived with the Band?
No. The band works by making you feel full and satisfied- in much the same way as you feel now after a meal, but achieves this with less food. Most patients say they actually enjoy their meals more. Taste is heightened, and food is now consumed for pleasure rather than to satisfy hunger. Bulk quantity consumption is replaced with quality eating.
Remember though that the band is a tool rather than a magic wand- you are still physically able to eat more than you need to if you ignore the feelings of fullness, and/or consume large amounts of liquid calories. We are here to help and guide you to allow you to get the most out of your band.
Can I eat anything in moderation?
The aim of the gastric band is not to reduce your range of food choices, just the quantity you need to feel full. Provided you chew well and eat slowly, band patients can eat almost anything. There are a couple of problem foods- fresh white bread and chewy steak can get stuck, and are probably best avoided. However wholemeal bread, toast, crackers, soft red meats, mince, chicken, fish, pasta, rice, salads, etc, are generally fine for most patients. Just ask our dietitians- we’re here to help.
Be aware that liquids and soft foods that are high in calories including chocolate, ice cream, milk shakes, soft-drinks, etc slip past the band very easily, and do not provide the same sense of satisfaction that solid foods do. Your weight loss may be greatly reduced or cancelled if you regularly consume these types of foods. We encourage you to eat real solid food, which will provide the best results.
How is the Band adjusted?
Adjustments are performed by Dr Hatzifotis. Occasionally they are done under Xray but this is seldom necessary. Local anaesthesia is available but is usually not needed as the fine needle is passed through the scar (which is usually numb) over the access-port. The process usually only takes a few minutes, and most patients say it is virtually painless. Whilst adjustments may be performed at any time, the majority are needed in the first 18 months or so.
Why are frequent clinic visits necessary after surgery?
As you lose weight, the amount of fat around your stomach will shrink, and your band will need to be adjusted in size to maintain the same feeling of hunger control. These regular visits will also provide an opportunity to check your band is functioning properly, and assist you with dietary advice and band support. Once your goal weight has been reached (usually around 18 months after surgery), appointments can then be scaled back to once or twice per year. Regular check-ups are a normal and a very important part of gastric banding follow-up.
Will I need to take vitamin supplements?
The gastric band does not cause malabsorption of nutrients- another advantage over other weight loss procedures. However we do recommend taking a daily mulitvitamin tablet to ensure you still receive your daily vitamin and mineral requirements given that you will be eating less.
What tests are needed before surgery?
Blood tests are performed routinely on all patients before surgery- This includes a full blood count, blood group, cholesterol levels, kidney, liver and thyroid function, and a diabetes screening test. Depending on your medical history, a chest Xray or an ECG may also be required.
Sometimes a referral to another specialist such as an endocrinologist, cardiologist, or respiratory physician may be required. This will be determined at your initial consultation with Dr Hatzifotis. If you already have other specialists involved in your care, we will correspond with them.
Do I need a referral from a General Practitioner?
Yes. A referral from a GP is a requirement under Medicare. We would also like to keep your GP informed about your management plan and subsequent progress.
How can I find out if my health fund will cover my hospital costs?
Contact your health fund and quote the Item Number for either the Gastric Band (31569) or the Sleeve Gatrectomy (31575). Sometimes it can seem a little difficult to get a straight answer! Patients often report being told that they will be covered up to the 'Scheduled Fee' or that 'if Medicare will pay 75% then the health fund will pay 25%', or 'if the procedure has been recommended by a doctor for health reasons it will be covered' etc. All of these responses mean that you are covered. (if you are still not sure, we can run a health fund check for you).
I have 'Top cover'- why do I still need to pay a gap?
Unfortunately the full costs involved in providing quality medical care are not adequately covered by the Gapcover fee arrangement. Irrespective of your level of cover, most common surgical procedures performed in the private health system involve a gap payment. Weigthloss surgery has even more costs, as multiple professionals are involved in your care, and care by your surgeon needs to be lifelong. Although a gap is payable, at least you can feel confident in the knowledge that the anaesthetist and assistant surgeon fees, and all of your standard aftercare is included, and there will not be any further charges at any stage.
QUESTIONS ABOUT THE GASTRIC SLEEVE
What is the main difference between the Sleeve Gastrectomy and the Gastric Band?
Whilst they both help control hunger and portion size, the Band uses a ring-shaped implanted device to do this, whilst the Sleeve involves removing part of the stomach to make it smaller.
How long has the Sleeve been around?
The sleeve has been performed worldwide over the past 7 years. It was initially developed as the first part of another weightloss operation called the 'Duodenal Switch'. High risk patients would have the sleeve part performed as a first stage operation, and then return for a second operation at a later date to complete the duodenal switch, in the belief that this staged strategy would lower their chance of complications. When it was observed that many of these first stage patients lost large amounts of weight without requiring the additional stage, the Sleeve Gastrectomy became a stand alone weightloss procedure. SInce then it has been further refined and studied, and has now become the fastest growing type of weightloss procedure in Australia and around the world.
Could there be any long term dangers of having part of the stomach removed?
Whilst the sleeve operation for obesity is still relatively new, similar operations that involve the removal of part or all of the stomach have been performed for over 100 years for conditions such as cancer, benign lesions, and stomach ulcers. We have learnt from these operations that a person can survive perfectly well without part of their stomach. Because the lower part of the stomach (the Antrum) is kept during the Sleeve Gastrectomy procedure, vitamin B12 absorption is maintained, and Iron, Calcium and folate levels remain unaffected. There is no risk of malabsorption with the Sleeve, and every nutrient that is consumed will travel through the gastrointestinal tract normally. A single daily multivitamin is recommended however as you will be eating less food. Its also a good idea to check that your essential vitamin and element levels remain normal by having an annual blood test.
Could the stomach Sleeve stretch over time?
Yes, the stomach does have a tendency to stretch, particularly if a person regularly tries to eat more than can be comfortably held. This is a longer term problem rather than something that is seen in the first few years. It is important that a person having the sleeve gastrectomy respects their new smaller stomach and avoids overeating. As with all weightloss procedures, there is a need to complement the surgery with changes in eating behaviours, lifestyle, and exercise levels. The chances of the sleeve stretching are greatly reduced when a patient works with their sleeve as a tool, maintains regular contact with the clinic, and makes a genuine attempt to improve diet and lifestyle. However, in the event of a significant increase in the stomach capacity over time, there are a number of rescue procedures that have been proposed to make the stomach smaller again. These include re-sleeving the stomach, using sutures to reduce the stomach, placing a Gastric Band around the top, or converting to a Gastric Bypass procedure. The relative merit of these various approaches is currently under study.
Is the Sleeve reversible?
No, because part of the stomach is removed from the body, the sleeve operation cannot be reversed. Many patients are actually attracted to the sleeve because of this, as they feel it represents a more permanent solution to their weight problem.
How quickly is the weight lost with a Sleeve?
After a Gastric Sleeve, weight is generally lost more quickly than after Gastric Banding, at approximately 1-2kg per week. Most patients reach their goal weight within 9-12 months.